| NPI | 1528835311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEYMIAN LEVANTE CRISP Owner 336-933-1204 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251X00000X Supports Brokerage |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-02-01 |